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Abstract
Social quality focusses on the nature of ‘the social’, arguing that people are realised as social beings through interacting with a range of collectives, both from the formal world of systems and the informal lifeworld. Four conditional factors are necessary for this to occur, which at the same time are assumed to influence health and well-being: socio-economic security, social cohesion, social inclusion and social empowerment. In this paper we test the utility of social quality in explaining self-rated health as a response to arguments that the social determinants of health (SDH) framework often lacks a theoretical basis. We use multilevel models to analyse national English and Welsh data (the Citizenship Survey) to test for both individual- and neighbour-level affects. Our key findings are that (1) neighbourhood contextual (cross-level) effects are present with respect to collective action, personal trust, cross-cutting ties, income sufficiency, and income security; (2) measures of national, community and personal identity as indicators of social cohesion show clear associations with health alongside more common measures such as trust; (3) the security aspects of socioeconomic determinants are especially important (housing security, income sufficiency, and income security); (4) social rights, including institutional rights but especially civil rights have effects of particularly large magnitude. Social quality offers a theoretically-driven perspective on the SDH which has important policy implications and suggests a number of promising avenues for future research.
Highlights
Following the seminal UK Black Report (1980) evidence has been building on the social factors underpinning health
With one exception, individual-level associations were most in the direction consistent with social quality theory: higher levels of social quality were associated with higher levels of self-rated health
For most indicators that were significant in the unadjusted analyses, controlling for socio-demographics and area-level factors generally attenuated their association with health to some extent, but they remained independently significant, suggesting that social quality indicators explain independent variation in self-rated health at the individual level
Summary
Following the seminal UK Black Report (1980) evidence has been building on the social factors underpinning health. In recent years the social determinants of health (SDH) framework has been central to this research (Marmot and Wilkinson 2005), and the World Health Organisation’s highly influential report was a landmark (CSDH 2008). The SDH framework is an empirically-led endeavour concerned with identifying risk factors from a social epidemiological perspective. In this field, theoretical explanations have taken three main directions: psychosocial approaches, social production of disease/political economy of health, and eco-social frameworks (Solar and Irwin 2010:15). Social production of disease/political economy of health focusses on wider economic and political determinants, especially the structural causes of inequalities i.e. the unequal distribution of resources. Eco-social explanations conceive of health as complex, multi-layered, and dynamic, and mutually constituted by the biological, psychological, and wider organisation of society
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